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Biomedical subjects

Peter E Morris

Publications and source records attributed to Peter E Morris.

10 recordsLinked to original sources
PubMed2006

Safety and efficacy of affinity-purified, anti-tumor necrosis factor-alpha, ovine fab for injection (CytoFab) in severe sepsis.

OBJECTIVE: Tumor necrosis factor (TNF) is a critical inflammatory mediator in sepsis. This trial was designed to evaluate the safety and effectiveness of polyclonal ovine anti-TNF fragment antigen binding (Fab) fragments (CytoFab) on plasma TNF-alpha, interleukin-6 (IL-6), and interleukin-8 (IL-8) concentrations and the number of shock-free and ventilator-free days in severely septic patients. DESIGN: Phase II, randomized, blinded, placebo-controlled trial conducted from September 1997 to July 1998. SETTING: Nineteen intensive care units in the United States and Canada. PATIENTS: Eighty-one septic patients with either shock or two organ dysfunctions. INTERVENTIONS: Patients were randomized to receive CytoFab, infused as a 250-units/kg loading dose, followed by nine doses of 50 units/kg every 12 hrs, or 5 mg/kg human albumin as placebo. MEASUREMENTS AND MAIN RESULTS: CytoFab promptly reduced plasma TNF-alpha (p = .001) and IL-6 concentrations (p = .002) compared with placebo. CytoFab also significantly decreased TNF-alpha in bronchoalveolar lavage (BAL) fluid (p < .001). The number of shock-free days did not differ between CytoFab and placebo (10.7 vs. 9.4, respectively) (p = .270). CytoFab increased mean ventilator-free days (15.0 vs. 9.8 for placebo; p = .040) and ICU-free days (12.6 vs. 7.6 for placebo; p = .030) at day 28. All-cause, 28-day mortality rates were 37% (14/38) for placebo recipients, compared with 26% (11/43) for CytoFab recipients (p = .274). No differences in incidences of adverse events, laboratory, or vital sign abnormalities were observed between groups. Although 41% of CytoFab-treated patients developed detectable plasma levels of human anti-sheep antibodies, none demonstrated clinical manifestations during the 28-day study. CONCLUSIONS: CytoFab is well tolerated in patients with severe sepsis, effectively reducing serum and BAL TNF-alpha and serum IL-6 concentrations and increasing the number of ventilator-free and ICU-free days at day 28.

Animals↗
PubMed2005

Selective interference with the use of visual images in the symbolic distance paradigm.

Eight experiments investigated the effects of visual, spatial, auditory, and executive interference on the symbolic comparison of animal size and ferocity, semantic goodness of words, and numbers. Dynamic visual noise (DVN) and the reading of visually presented stimulus items were shown to selectively interfere with response times on the animal size comparison task, though the slope of the symbolic distance function remained unchanged. Increased change of DVN significantly increased interference, but interference was reduced by equiluminant DVN. Spatial tracking reduced the slope of the symbolic distance function in contrast to an executive task that only increased mean latency and errors for all comparisons. Results suggest that the generation of an image is necessary for size comparison, but neither imagery nor executive function is responsible for the frequently observed distance-time function.

Humans↗
PubMed2004

Drotrecogin alfa.

Drotrecogin alfa (activated) is a human recombinant protein that is intravenously administered in a continuous, weight-based dose for patients with severe sepsis. In patients with severe sepsis, thrombin has been implicated in the interrelationship between the coagulation and inflammation pathways. Thrombin is responsible for conversion of fibrinogen to fibrin (thrombus formation). Thrombin also activates endothelial cells, white blood cells and platelets. Regulation of both the coagulation and inflammation pathways is in part through the interaction of thrombin and activated protein C. Activated protein C has particular attributes that may inhibit microvascular thrombi, promote fibrinolysis and directly dampen the proinflammatory aspect of infection. In patients with severe sepsis, many investigators have demonstrated an active coagulopathic state, with low protein C levels. A phase III clinical trial has demonstrated reduced mortality in severe sepsis patients receiving activated protein C.

Animals↗
PubMed2004

Comparison of 3 methods of detecting acute respiratory distress syndrome: clinical screening, chart review, and diagnostic coding.

BACKGROUND: Although the incidence of acute respiratory distress syndrome has been studied, few researchers have prospectively assessed the search tool used to identify cases. METHODS: For 5 months, all patients admitted to a medical intensive care unit in a teaching hospital were evaluated daily to determine whether criteria for acute respiratory distress syndrome were met, and physicians' progress notes and discharge summaries for these prospectively identified patients were reviewed for mention of the syndrome. Discharge forms were reviewed for the codes (International Classification of Diseases, Ninth Revision) specific to acute respiratory distress syndrome (518.82 or 518.85). RESULTS: Of 314 patients admitted, 65 prospectively met the criteria for acute respiratory distress syndrome. Of these 65 patients, 31 had acute respiratory distress syndrome mentioned in their progress notes, and 4 of the 31 were subsequently assigned a code of 518.82 or 518.85. Patients with a physician's notation for acute respiratory distress syndrome in their charts had a higher mortality (22/31 [71%]) than did the patients with no such notation (10/34 [29%]). This difference could not be accounted for by differences in length of stay, mean age, score on Acute Physiology and Chronic Health Evaluation III, or number of days in the unit before meeting the criteria. CONCLUSIONS: The incidence of acute respiratory distress syndrome is underestimated when based on either diagnostic coding or physicians' notes without testing of the accuracy of coding. Both physicians and medical record coding specialists may require training in use of terms related to acute respiratory distress syndrome.

APACHE↗
PubMed2003

The relationship between self-reports of imagery and spatial ability.

A puzzling question arising from imagery research is why no relationship has been found between self-reports of imagery and performance on spatial tests thought to require the use of imagery. To investigate this, spatial ability, measured by performance on two spatial tests, was compared with performance on the Vividness of Visual Imagery Questionnaire (VVIQ; Marks, 1973) and a newly constructed imagery questionnaire. The choice of items and ratings for the new questionnaire was based on Kosslyn's (1980, 1994) theories of the imagery system. Ratings on the new questionnaire consistently correlated significantly with performance on the spatial tests, whereas ratings from the VVIQ did not. The new ratings captured more of the imagery process than ratings of vividness alone, but the largest change depended upon the type of item imagined. Ratings of items of the same type as used on the spatial tests predicted performance on the spatial tests, whereas vividness ratings of items recalled or constructed from long-term memory did not. Participants can successfully introspect on several different properties of their images, and their ratings do predict performance on tasks thought to require imagery. The large effect of item type raises questions about the predictive value of existing models of the imagery system especially in relation to the role of phenomenological properties of our images.

Adolescent↗
PubMed2003

Attractiveness, distinctiveness, and recognition of faces: attractive faces can be typical or distinctive but are not better recognized.

The debate surrounding the relationship between facial attractiveness and distinctiveness appears to arise from different definitions of distinctiveness. In our study unfamiliar faces were rated for attractiveness, age, and distinctiveness. Two measures of distinctiveness were used: ease of spotting the face in a crowd (traditional) and deviation from an average face (deviation). Recognition was not predicted by attractiveness. The traditional ratings produced a complex relationship with attractiveness, where unattractive faces were distinctive, but attractive faces were rated at all levels of distinctiveness. When the effects of age were partialled out, attractiveness no longer predicted traditional distinctiveness. However, deviation ratings produced a strong negative correlation with attractiveness, even when the effects of age were removed.

Adult↗
PubMed2002

Identifying patients with severe sepsis who should not be treated with drotrecogin alfa (activated).

Historically, clinical trials evaluating treatment of patients with severe sepsis have failed to show a reduction of mortality. However, retrospective analyses of some of these trials showed benefits in certain patient subgroups. Conversely, the recent Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) trial, which evaluated the safety and efficacy of drotrecogin alfa (activated) (Xigris; Eli Lilly and Company, Indianapolis, IN), a recombinant form of human activated protein C, in adult patients with severe sepsis, is notable in that it is the first trial to show a reduction in 28-day all-cause mortality in the intent-to-treat population compared with the placebo group. When assessing a new intervention, patient exclusion criteria are important considerations in evaluating the evidence from a controlled clinical trial. Appropriate patient selection will be a key factor in the use of this newly approved therapeutic agent to treat severe sepsis. A review of the exclusion criteria used in the PROWESS trial should provide clinicians with a way of differentiating those patients in the critical care setting who will benefit most from treatment with drotrecogin alfa (activated) from those who should not be treated.

APACHE↗
PubMed2002

The improved name game: better use of expanding retrieval practice.

Morris and Fritz (2000) demonstrated the effectiveness of the name game as a retrieval-practice based technique for learning the names of group members. We hypothesised that a reversed version of the name game would be even more effective. Performance was contrasted with a no-retrieval condition that mimicked the name game in every way except for the retrieval of the names, allowing an estimate of the specific contribution of retrieval practice. The benefit of a few refresher rounds of the game after 2 weeks was also examined. The reversed name game was superior to the original name game and the refresher rounds benefited all groups. The very considerable superiority of the name game over the no-retrieval condition demonstrated the magnitude of the benefit of expanding retrieval practice.

Adult↗
PubMed2002

Relationship between the inflammation and coagulation pathways in patients with severe sepsis: implications for therapy with activated protein C.

In patients with severe sepsis, thrombin has been implicated in the interrelationship between the coagulation and inflammation pathways. Thrombin is responsible for conversion of fibrinogen to fibrin (thrombus formation). Thrombin also activates endothelial cells, white blood cells and platelets. Regulation of both the coagulation and inflammation pathways is in part through the interaction of thrombin and activated protein C. Activated protein C has particular attributes that may inhibit microvascular thrombi, promote fibrinolysis and directly dampen the pro-inflammatory aspect of infection. In patients with severe sepsis, many investigators have demonstrated an active coagulopathic state, with low protein C levels. A phase III clinical trial has now demonstrated reduced mortality in patients with severe sepsis receiving activated protein C.

Anticoagulants↗